Grant, Edward Keith
Grant, Edward Keith is an individual health care provider with primary practice located at 3708 Northside Dr , Macon GA 31210-2404. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Grant, Edward Keith can be contacted via phone (478) 745-4206.Contact Information
Primary practice address
3708 Northside Dr
Macon GA 31210-2404
Phone: (478) 745-4206
Fax: (478) 254-5463
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 004120 | Georgia |
Profile Details
| NPI number | 1245236744 |
|---|---|
| LBN Legal business name | Grant, Edward Keith |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2005 |
| Last updated | Jun 1st, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245236744 | NPPES |
| Georgia | MEDICAID | 542228866E | |
| Georgia | Other | P00758778 |
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